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1.
J Surg Res ; 257: 363-369, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32892132

RESUMO

BACKGROUND: Popliteal artery injuries are the second most common arterial injuries below the inguinal ligament. We aimed to compare outcomes in patients with popliteal injuries by hospital teaching status utilizing the National Trauma Data Bank Research Data Set (NTDB-RDS) 2013-2016. METHODS: Four-year retrospective study using the NTDB-RDS, evaluating popliteal vascular injuries. Patients were divided by popliteal injury type and teaching status into; nonteaching hospital (NTH), community teaching (CTH), or University teaching (UTH). Demographics and outcome measures were compared between groups. Risk-adjusted mortality odds ratios (ORs) were calculated. Significance was defined as P < 0.05. RESULTS: 3,577,168 patients were in the NTDB-RDS, with 1120 having a popliteal injury, (incidence = 0.03%). There was no significant difference in the amputation rate between patients treated in NTHs, CTHs, or UTHs (P > 0.05). There was no significant difference in the raw mortality rate between patients treated in NTHs, CTHs, or UTHs. After adjusting for confounders; compared to NTH, the odds ratio for mortality for popliteal artery injuries in the CTH group was significantly higher (OR: 15.95, 95% CI: 1.19-213.84), and for the UTH group the mortality was also significantly higher (OR: 5.74, 95% CI: 0.45-72.95). CONCLUSIONS: The incidence of popliteal vascular injuries was 0.03% for 2013-2016. Patients with popliteal artery injuries treated at community teaching hospitals have a 16 times higher risk of mortality and at university teaching hospitals have a 5.7 times higher risk of mortality than patients treated at nonteaching hospitals.


Assuntos
Hospitais Universitários/estatística & dados numéricos , Artéria Poplítea/lesões , Lesões do Sistema Vascular/mortalidade , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
2.
JAMA Netw Open ; 3(12): e2027920, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33372972

RESUMO

Importance: Functional seizures (formerly psychogenic nonepileptic seizures), paroxysmal episodes that are often similar to epileptic seizures in their clinical presentation and display no aberrant brain electrical patterns, are understudied. Patients experience a long diagnostic delay, few treatment modalities, a high rate of comorbidities, and significant stigma due to the lack of knowledge about functional seizures. Objective: To characterize the clinical epidemiology of a population of patients with functional seizures observed at Vanderbilt University Medical Center (VUMC). Design, Setting, and Participants: This case-control study included patients with functional seizures identified in the VUMC electronic health record (VUMC-EHR) system from October 1989 to October 2018. Patients with epilepsy were excluded from the study and all remaining patients in the VUMC medical center system were used as controls. In total, the study included 1431 patients diagnosed with functional seizures, 2251 with epilepsy and functional seizures, 4715 with epilepsy without functional seizures, and 502 200 control patients who received treatment at VUMC for a minimum of a 3 years. Data were analyzed from November 2018 to March 2020. Exposure: Diagnosis of functional seizures, as identified from the VUMC-EHR system by an automated phenotyping algorithm that incorporated International Classification of Diseases, Ninth Revision (ICD-9) codes, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes, Current Procedural Terminology codes, and natural language processing. Main Outcomes and Measures: Associations of functional seizures with comorbidities and risk factors, measured in odds ratios (ORs). Results: Of 2 346 808 total patients in the VUMC-EHR aged 18 years or older, 3341 patients with functional seizures were identified (period prevalence, 0.14%), 1062 (74.2%) of whom were women and for which the median (interquartile range) age was 49.3 (39.4-59.9) years. This assessment replicated previously reported associations with psychiatric disorders including posttraumatic stress disorder (PTSD) (OR, 1.22; 95% CI, 1.21-1.24; P < 3.02 × 10-5), anxiety (OR, 1.14; 95% CI, 1.13-1.15; P < 3.02 × 10-5), and depression (OR, 1.14; 95% CI, 1.13-1.15; P < 3.02 × 10-5), and identified novel associations with cerebrovascular disease (OR, 1.08; 95% CI, 1.06-1.09; P < 3.02 × 10-5). An association was found between functional seizures and the known risk factor sexual assault trauma (OR, 10.26; 95% CI, 10.09-10.44; P < 3.02 × 10-5), and sexual assault trauma was found to mediate nearly a quarter of the association between female sex and functional seizures in the VUMC-EHR. Conclusions and Relevance: This case-control study found evidence to support previously reported associations, discovered new associations between functional seizures and PTSD, anxiety, and depression. An association between cerebrovascular disease and functional seizures was also found. Results suggested that sexual trauma may be a mediating factor in the association between female sex and functional seizures.


Assuntos
Transtornos Mentais/epidemiologia , Convulsões/epidemiologia , Adulto , Ansiedade/epidemiologia , Estudos de Casos e Controles , Comorbidade , Diagnóstico Tardio , Depressão/epidemiologia , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Convulsões/etiologia , Convulsões/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia
3.
G Ital Nefrol ; 37(5)2020 Oct 05.
Artigo em Italiano | MEDLINE | ID: mdl-33026200

RESUMO

The epidemic wave that hit Italy from February 21st, 2020, when the Italian National Institute of Health confirmed the first case of SARS­CoV­2 infection, led to a rapid and efficient reorganization of Dialysis Centers' activities, in order to contain large-scale spread of disease in this clinical setting. We herein report the experience of the Hemodialysis Unit of Parma University Hospital (Azienda Ospedaliero-Universitaria, Parma, Italy) and the Dialysis Centers of Parma territory, in the period from March 1st, 2020 to June 15, 2020. Among patients undergoing chronic haemodialysis, 37/283 (13%) had positive swabs for SARS­CoV­2, 9/37 (24%) died because of COVID-19. Twenty-three patients required hospitalization, while the remaining were managed at home. The primary measures applied to contain the infection were: the strengthening of personal protective equipment use by doctors and nurses, early identification of infected subjects by performing oro-pharyngeal swabs in every patient and in the healthcare personnel, the institution of a triage protocol when entering Dialysis Room, and finally the institution of two separate sections, managed by different doctors and dialysis nurses, to physically separate affected from unaffected patients and to manage "grey" patients. Our experience highlights the importance and effectiveness of afore-mentioned measures in order to contain the spread of the virus; moreover, we observed a higher lethality rate of COVID-19 in dialysis patients as compared to the general population.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Unidades Hospitalares de Hemodiálise/organização & administração , Reestruturação Hospitalar , Falência Renal Crônica/terapia , Pandemias , Pneumonia Viral/epidemiologia , Diálise Renal , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Diagnóstico Precoce , Emergências , Unidades Hospitalares de Hemodiálise/estatística & dados numéricos , Hemodiálise no Domicílio/estatística & dados numéricos , Mortalidade Hospitalar , Hospitais Universitários/estatística & dados numéricos , Humanos , Controle de Infecções/métodos , Itália/epidemiologia , Falência Renal Crônica/epidemiologia , Nasofaringe/virologia , Pandemias/prevenção & controle , Isolamento de Pacientes , Diálise Peritoneal , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Utilização de Procedimentos e Técnicas , Triagem
4.
PLoS One ; 15(10): e0239744, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33057417

RESUMO

BACKGROUND: Globally, health care-associated infections had become serious public health importance. Compliance with standard safety precaution is effective and inexpensive measure to improve quality of healthcare in reducing occurrence of healthcare associated infections. In developing countries, like Ethiopia adherence to recommended standard safety precaution is scanty. OBJECTIVE: To assess level of compliance with standard safety precaution and associated factors among healthcare workers in Hawassa comprehensive specialized hospital Southern Ethiopia. METHODS: An institutional based cross-sectional study was conducted at Hawassa comprehensive specialized hospital. Data were collected by using self-administered questionnaire. Study participants were allocated proportionally based on their profession by using stratified random sampling method. Data were entered and analyzed by using SPSS version 20.0. Bi-variable analysis and multi variable logistic regression model were used to check which variables were associated with dependent variable. P-values ≤ 0.05 were considered statistically significant. In this study the overall compliance with standard safety precaution among healthcare workers were only 56.5%. Being female healthcare worker AOR: 2.76(1.34, 5.54), married healthcare workers AOR: 4.2(2, 9.03), accessibility of safety box AOR: 3.4(1.6, 7.17), HCWs had perceived IP training AOR: 3.99(1.46, 10.9), availability of tape water AOR: 2.68(1.15, 6.2) and healthcare workers had internal infection prevention and control supportive supervision AOR: 5.8(2.54, 13.48) associated with compliance with standard safety precaution. CONCLUSION: According to findings of the current study, overall level of compliance with standard SP among HCWs considered to be very low. Factors such as healthcare workers being female, accessibility of safety box, availability of running tape water, training and supportive supervision were independent predictors of compliance with standard safety precaution. Thus ensuring availability and accessibility of safety precaution materials and regular observing and supervising healthcare workers' practices are highly recommended.


Assuntos
Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Hospitais Especializados/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Gestão da Segurança/estatística & dados numéricos , Universidades/estatística & dados numéricos , Adulto , Infecção Hospitalar/prevenção & controle , Estudos Transversais , Etiópia , Feminino , Humanos , Controle de Infecções/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
5.
Educ. med. (Ed. impr.) ; 21(5): 299-305, sept.-oct. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-196873

RESUMO

Aunque todas las especialidades incorporan en sus programas formativos los objetivos relacionados con la adquisición de competencias y habilidades en investigación, la valoración de los residentes en cuanto a la formación recibida y el tiempo de dedicación es deficiente. El presente estudio trata de evaluar el impacto de una nueva estrategia formativa en investigación, que incorpora un nivel básico y un nivel avanzado con el desarrollo y puesta en marcha durante la residencia de un proyecto de investigación. La presentación de dicho proyecto permite aplicar los conocimientos teóricos adquiridos, tratando de responder de forma sistematizada y metódica a una pregunta de investigación que surja de la observación de la práctica clínica diaria. Tras 4 ediciones, el 100% de los residentes presentó algún trabajo a congresos, el 27% presentaron más de 30 y el 33% presentaron entre 20 y 30. El 64% terminaron la formación con publicaciones científicas y la valoración de la formación percibida por el residente ha mejorado en las encuestas de satisfacción, siendo de excelente o muy buena en más de un 55%. Un programa de formación con un nivel básico y avanzado de investigación que concluya con la puesta en marcha de un proyecto de investigación podría mejorar los indicadores de la actividad investigadora de residentes y de especialistas de un hospital universitario, aspectos que contribuyen a la adquisición de competencias y el cumplimiento de objetivos del programa de la especialidad


All the specialties incorporate objectives related to the acquisition of competences and skills in research in their training programs. However, from the point of view of residents, the training received and the length of time seems deficient. The present study attempts to evaluate the impact of a new training strategy in research, which incorporates a basic level and an advanced level with the development and implementation of a research project during the residency. The presentation of this project allows the acquired theoretical knowledge to be applied, trying to answer a research question that arises from the observation in the daily clinical practice. After 4 editions, 100% of the residents presented some work at congresses, with 27% presenting more than 30, and 33% presenting between 20 and 30. Almost two-thirds (64%) finished the training period with scientific publications. The evaluation of the training programme has also improved in the satisfaction surveys, being excellent or very good in more than 55%. A speciality training program with a basic and advanced level of research with a research project performed during the residency could improve the indicators in relation to research activity of residents and specialists in a university hospital. These aspects could contribute to the acquisition of competencies and compliance with the objectives of the specialty program


Assuntos
Humanos , Educação de Pós-Graduação em Medicina/métodos , Avaliação Educacional/métodos , Hospitais Universitários/estatística & dados numéricos , Pesquisa/educação , Internato e Residência , Educação/organização & administração , Estatística como Assunto/educação , Análise de Dados , Medicina/classificação , Medicina/estatística & dados numéricos
6.
J Korean Med Sci ; 35(36): e328, 2020 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-32924343

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) was first reported in December 2019 in China, and then it has disseminated worldwide. In Korea, a religious group-related super-spreading event triggered a sudden outbreak in Daegu city and Gyeongsangbuk-do in southeast Korea. This study was undertaken to document the clinical characteristics of patients hospitalized in Gyeongsangbuk-do. METHODS: Three hundred and fifty-two patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection hospitalized at Dongguk University Gyeongju Hospital or at the Andong Medical Center between February 18th and June 30th were enrolled in this study. Medical records were reviewed and demographic and clinical features, including comorbidities, symptoms, radiological and laboratory findings on admission were analyzed. In addition, we sought to identify risk factors of mortality. RESULTS: Mean age of the 352 study subjects was 56 years (range, 14-95). The mortality rate was 6.8% and mean age at death was 81 years (range, 57-91). The most common symptom was cough (31.8%) followed by a febrile sensation (28.4%), sputum (17.0%), sore throat (15.6%), and myalgia (13.1%). Eighty-one (23.0%) patients were asymptomatic, but a half of these patients exhibited pneumonic infiltration at presentation. Chest radiology showed no active lesion in 41.8% of the study subjects, bilateral pneumonia in 46.9%, and unilateral pneumonic infiltration in 11.4%. Among 24 patients that died, 18 subjects were transferred from a care facility. An age of ≥ 70 years, previous history of malignancy or diabetes, and fever (≥ 37.5°C) on admission were found to be significant risk factors of mortality. CONCLUSION: Patients aged ≥ 70 years, those with fever on admission, and patients with an underlying malignancy or diabetes were found to be more likely to succumb to COVID-19. Elderly in care facilities or hospitalized patients with an underlying disease should receive more attention and be considered for preventive quarantine.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Hospitais Especializados/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Pacientes Internados , Pandemias , Pneumonia Viral/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Comorbidade , Infecções por Coronavirus/diagnóstico por imagem , Diabetes Mellitus/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Pneumonia Viral/diagnóstico por imagem , Quarentena , República da Coreia/epidemiologia , Fatores de Risco , Avaliação de Sintomas
7.
PLoS One ; 15(9): e0238587, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881963

RESUMO

OBJECTIVE: We aimed to evaluate the effects of combining the Simplified-Acute-Physiology-Score (SAPS) 2 or the SAPS 3 with Interleukin-6 (IL-6) or Procalcitonin (PCT) or C-Reactive Protein (CRP) concentrations for predicting in-hospital mortality. MATERIAL AND METHODS: This retrospective study was conducted in an interdisciplinary 22-bed intensive care unit (ICU) at a German university hospital. Within an 18-month period, SAPS 2 and SAPS 3 were calculated for 514 critically ill patients that were admitted to the internal medicine department. To evaluate discrimination performance, the area under the receiver operating characteristic curves (AUROCs) and the 95% confidence intervals (95% CIs) were calculated for each score, exclusively or in combination with IL-6 or PCT or CRP. DeLong test was used to compare different AUROCs. RESULTS: The SAPS 2 exhibited a better discrimination performance than SAPS 3 with AUROCs of 0.81 (95% CI, 0.76-0.86) and 0.72 (95% CI, 0.66-0.78), respectively. Overall, combination of the SAPS 2 with IL-6 showed the best discrimination performance (AUROC 0.82; 95% CI, 0.77-0.87), albeit not significantly different from SAPS2. IL-6 performed better than PCT and CRP with AUROCs of 0.75 (95% CI, 0.69-0.81), 0.72 (95% CI, 0.66-0.77) and 0.65 (95% CI, 0.59-0.72), respectively. Performance of the SAPS 3 improved significantly when combined with IL-6 (AUROC 0.76; 95% CI, 0.69-0.81) or PCT (AUROC 0.73; 95% CI, 0.67-0.78). CONCLUSIONS: Our analysis provided evidence that the risk stratification performance of the SAPS 3 and, to a lesser degree, also of the SAPS 2 can increase when combined with IL-6. A more accurate detection of aberrant or dysregulated systemic immunological responses (by IL-6) may explain the higher performance achieved by SAPS 3 + IL-6 vs. SAPS 3. Thus, implementation of IL-6 in critical care scores can improve prediction outcomes, especially in patients experiencing acute inflammatory conditions; however, statistical results may vary across hospital types and/or patient populations with different case mix.


Assuntos
Doença Aguda/mortalidade , Cuidados Críticos/estatística & dados numéricos , Mortalidade Hospitalar , Hospitais Universitários/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Escala Psicológica Aguda Simplificada , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Proteína C-Reativa/análise , Feminino , Alemanha , Humanos , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Pró-Calcitonina/sangue , Prognóstico , Estudos Retrospectivos , Adulto Jovem
8.
Metas enferm ; 23(7): 24-32, sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-196459

RESUMO

OBJETIVO: identificar las principales barreras percibidas para la utilización de la investigación en la práctica clínica por parte de las enfermeras. MÉTODO: se realizó un estudio descriptivo transversal mediante la administración del cuestionario de "Barreras para la utilización de la investigación enfermera" en profesionales de Enfermería que estaban trabajando en el Consorci Corporació Parc Taulí de Sabadell (Barcelona) en mayo-septiembre de 2017. El muestreo fue no probabilístico accidental. La distribución de este cuestionario autoadministrado se efectuó vía online. Se llevó a cabo análisis univariante y bivariante. Se consideró que había diferencias estadísticamente significativas si la p< 0,05. RESULTADOS: participaron 276 profesionales de Enfermería. 244 (88,4%) mujeres. La media (DE) de experiencia laboral fue de 18,7 años (10,4) y de 11,32 años (8) de experiencia en el servicio en el que trabajaban en el momento del estudio. Un 46,7% recibió formación pregrado en investigación y un 70,3% postgrado. Las participantes consideran que la investigación es una actividad necesaria (88,8%) que contribuye al desarrollo de la profesión (98,9%), aunque opinan que requiere una gran inversión de tiempo y esfuerzo (94,9%) para poder llevarla a cabo. Las tres barreras identificadas con mayor puntuación fueron "los artículos/informes de investigación se publican con mucha demora" con una media (DE) de 3,03 (0,89), "los médicos no colaboran en la implementación" con una media (DE) de 2,99 (0,90) y "no hay tiempo suficiente en el trabajo para implementar nuevas ideas" con una media (DE) de 2,98 (1,03). CONCLUSIÓN: las principales barreras identificadas en este estudio por parte de los profesionales de Enfermería que han participado han sido falta de tiempo, falta de conocimientos en metodología investigadora y la percepción de falta de apoyo institucional


OBJECTIVE: to identify the main barriers perceived for the use of research in clinical practice by nurses. METHOD: a descriptive cross-sectional study, conducted through the administration of the Questionnaire on Barriers for the Use of Nursing Research by Nursing professionals, which was prepared by the Consorci Corporació Parc Taulí of Sabadell (Barcelona) during May-September, 2017. There was non-probabilistic accidental sampling. This self-administered questionnaire was distributed online. Univariate and bivariate analyses were conducted. It was considered that there were statistically significant differences if p < 0.05. RESULTS: the study included 276 Nursing professionals; 244 (88.4%) were women. Their mean (SD) work experience was 18.7 years (10.4) and 11.32 years (8) of experience at the Hospital Unit where they worked at the time of the study. Of them, 46.7% had received undergraduate training in research, and 70.3% postgraduate. The participants considered that research is a necessary activity (88.8%) which contributes to the development of the profession (98.9%); although they reckon that it requires a major investment in time and effort (94.9%). The three barriers identified with the highest scores were: "research articles / reports are published with delay" with a mean (SD) 3.03 (0.89), "there is no collaboration by physicians in their implementation" with a mean (SD) 2.99 (0.90) and "there is not enough time at work to implement new ideas" with a mean (SD) 2.98 (1.03). CONCLUSION: the main barriers identified in this study by Nursing professionals who have participated are: lack of time, lack of knowledge regarding research methodology, and the perceived lack of support by the institutions


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Atitude do Pessoal de Saúde , Pesquisa em Enfermagem/métodos , Hospitais Universitários/estatística & dados numéricos , Enfermagem Prática , Barreiras ao Acesso aos Cuidados de Saúde , Estudos Transversais , Inquéritos e Questionários , Análise de Variância , Enfermeiras e Enfermeiros/estatística & dados numéricos
9.
Anaesthesist ; 69(10): 717-725, 2020 10.
Artigo em Alemão | MEDLINE | ID: mdl-32821955

RESUMO

BACKGROUND: Following the regional outbreak in China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world, presenting the healthcare systems with huge challenges worldwide. In Germany the coronavirus diseases 2019 (COVID-19) pandemic has resulted in a slowly growing demand for health care with a sudden occurrence of regional hotspots. This leads to an unpredictable situation for many hospitals, leaving the question of how many bed resources are needed to cope with the surge of COVID-19 patients. OBJECTIVE: In this study we created a simulation-based prognostic tool that provides the management of the University Hospital of Augsburg and the civil protection services with the necessary information to plan and guide the disaster response to the ongoing pandemic. Especially the number of beds needed on isolation wards and intensive care units (ICU) are the biggest concerns. The focus should lie not only on the confirmed cases as the patients with suspected COVID-19 are in need of the same resources. MATERIAL AND METHODS: For the input we used the latest information provided by governmental institutions about the spreading of the disease, with a special focus on the growth rate of the cumulative number of cases. Due to the dynamics of the current situation, these data can be highly variable. To minimize the influence of this variance, we designed distribution functions for the parameters growth rate, length of stay in hospital and the proportion of infected people who need to be hospitalized in our area of responsibility. Using this input, we started a Monte Carlo simulation with 10,000 runs to predict the range of the number of hospital beds needed within the coming days and compared it with the available resources. RESULTS: Since 2 February 2020 a total of 306 patients were treated with suspected or confirmed COVID-19 at this university hospital. Of these 84 needed treatment on the ICU. With the help of several simulation-based forecasts, the required ICU and normal bed capacity at Augsburg University Hospital and the Augsburg ambulance service in the period from 28 March 2020 to 8 June 2020 could be predicted with a high degree of reliability. Simulations that were run before the impact of the restrictions in daily life showed that we would have run out of ICU bed capacity within approximately 1 month. CONCLUSION: Our simulation-based prognosis of the health care capacities needed helps the management of the hospital and the civil protection service to make reasonable decisions and adapt the disaster response to the realistic needs. At the same time the forecasts create the possibility to plan the strategic response days and weeks in advance. The tool presented in this study is, as far as we know, the only one accounting not only for confirmed COVID-19 cases but also for suspected COVID-19 patients. Additionally, the few input parameters used are easy to access and can be easily adapted to other healthcare systems.


Assuntos
Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Número de Leitos em Hospital , Hospitais Universitários/organização & administração , Unidades de Terapia Intensiva/organização & administração , Pneumonia Viral/terapia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/estatística & dados numéricos , Alemanha , Hospitais Universitários/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Prognóstico
10.
Swiss Med Wkly ; 150: w20331, 2020 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-32799308

RESUMO

AIMS OF THE STUDY: While COVID-19 significantly overburdens emergency rooms (ERs) and hospitals in affected areas, ERs elsewhere report a marked decrease in patient numbers. This study aimed to investigate the assumption that patients with urgent problems currently avoid the ER. METHODS: Electronic health records from the ER of a large Swiss university hospital were extracted for three periods: first, the awareness phase (ap) from the publication of the national government’s initiative “How to protect ourselves” on 1 March 2020 to the lockdown of the country on 16 March; second, the mitigation phase (mp) from 16–30 March; finally, patients presenting in March 2019 were used as a control group. We compared parameters including a critical illness as the discharge diagnosis (e.g., myocardial infarction, stroke, sepsis and ER death) using logistic and linear regression, as well as 15-day bootstrapped means and 95% confidence intervals for the control group. RESULTS: In the three periods, a total of 7143 patients were treated. We found a 24.9% (42.5%) significant decline in the number of patients presenting during the ap (mp). Patients presenting during the mp were more likely to be critically ill. There was an increase of 233% and 367% (ap and mp, respectively) of ER deaths (none related to COVID-19) compared with the control period. Apart from polytrauma (increase of 5% in the mp), all other critical illnesses as discharge diagnosis showed a lower incidence in descriptive analysis. Significantly more patients died in the ER in both the ap and mp. CONCLUSIONS: Barriers to seeking emergency care during COVID-19 pandemic may lead to higher morbidity and mortality. Healthcare authorities and hospitals must ensure low barriers to treatment and business as usual for all patients.


Assuntos
Infecções por Coronavirus/epidemiologia , Estado Terminal/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Acesso aos Serviços de Saúde/tendências , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adulto , Idoso , Betacoronavirus , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Análise de Regressão , Estudos Retrospectivos , Suíça/epidemiologia
11.
PLoS One ; 15(8): e0237159, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760101

RESUMO

BACKGROUND: Computerized Clinical Decision Support Systems (CCDSS) have become increasingly important in ensuring patient safety and supporting all phases of clinical decision making. The aim of this study is to evaluate, through a CCDSS, the rate of the laboratory tests overuse and to estimate the cost of the inappropriate requests in a large university hospital. METHOD: In this observational study, hospital physicians submitted the examination requests for the inpatients through a Computerized Physician Order Entry. Violations of the rules in tests requests were intercepted and counted by a CCDSS, over a period of 20 months. Descriptive and inferential statistics (Student's t-test and ANOVA) were made. Finally, the monthly comprehensive cost of the laboratory tests was calculated. RESULTS: During the observation period a total of 5,716,370 requests were analyzed and 809,245 violations were counted. The global rate of overuse was 14.2% ± 3.0%. The most inappropriate exams were Alpha Fetoprotein (85.8% ± 30.5%), Chlamydia trachomatis Nucleic Acid Amplification (48.7% ± 8.8%) and Alkaline Phosphatase (20.3% ± 6.5%). The monthly cost of over-utilization was 56,534€ for basic panel, 14,421€ for coagulation, 4,758€ for microbiology, 432€ for immunology exams. All the exams, generated an estimated avoidable cost of 1,719,337€ (85,967€ per month) for the hospital. CONCLUSIONS: The study confirms the wide variability in over-utilization rates of laboratory tests. For these reasons, the real impact of inappropriateness is difficult to assess, but the generated costs for patients, hospitals and health systems are certainly high and not negligible. It would be desirable for international medical communities to produce a complete panel of prescriptive rules for all the most common laboratory exams that is useful not only to reduce costs, but also to ensure standardization and high-quality care.


Assuntos
Técnicas de Laboratório Clínico/economia , Custos e Análise de Custo , Sistemas de Apoio a Decisões Clínicas/economia , Utilização de Instalações e Serviços/estatística & dados numéricos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Sistemas de Apoio a Decisões Clínicas/estatística & dados numéricos , Utilização de Instalações e Serviços/economia , Hospitais Universitários/economia , Hospitais Universitários/estatística & dados numéricos
12.
Emergencias ; 32(4): 227-232, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32691999

RESUMO

OBJECTIVES: To evaluate the effectiveness of a coronavirus disease 2019 (COVID-19) prevention and control program for health care workers in a tertiary care hospital emergency department (ED). MATERIAL AND METHODS: We recorded the number of confirmed COVID-19 workers in the ED on March 2, 2020, and April 12, 2020. Workers were screened if they had symptoms or were traced as contacts. Variables recorded were age, sex, staff position, work area, and reason for contact. We used the χ2 test to compare ED workers to workers in other areas of the health care system. RESULTS: Of the 3900 health care workers (279 in the ED), 1744 cases (92 in the ED) were included for analysis. A total of 736 workers (52 in the ED) had symptoms, and 151 had positive test results (9 from the ED). Two of the infections in the ED workers (22.2%) were attributed to patient contact and 7 (77.8%) to nonwork-related contact either in the workplace or in the community. The prevalence of COVID-19 among ED workers was 3.2% (9/279). The prevalence among other health system workers was 3.9% (142/3621). The differences in COVID-19 prevalence between the 2 groups was not significant. Nor was there a significant difference in the reasons for contact with the virus between the 2 groups. CONCLUSION: Based on the prevalence of COVID-19 among ED workers and other health care workers, the reasons for risk of contact with the virus, and the time frame for gathering the data, we conclude that the prevention and control measures in the ED have been effective.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Pneumonia Viral/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Adulto , Idoso , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Prevalência , Avaliação de Programas e Projetos de Saúde , Espanha/epidemiologia
14.
Rev Bras Enferm ; 73 Suppl 2: e20200434, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32667576

RESUMO

OBJECTIVE: to identify prevalence and factors associated with anxiety and depression in nursing professionals who work to cope with COVID-19 at a university hospital. METHODS: a cross-sectional observational study using a sociodemographic questionnaire and Hospital Anxiety and Depression Scale, with 88 nursing professionals. Data were analyzed using absolute and relative frequency and Statistical Package for the Social Sciences. RESULTS: there was prevalence of anxiety (48.9%) and depression (25%). The majority of the sample consisted of women over 40 years old, married or in a common-law marriage, white, with higher education or graduate degree, with an income above 3,000.00 reais, public servants, working 40 hours a week and working in the hospital from 1 to 5 years. CONCLUSION: we must consider the impact on mental health nursing caused by COVID-19 and intervene with coping strategies to minimize the suffering of professionals.


Assuntos
Adaptação Psicológica , Ansiedade/etiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/enfermagem , Depressão/etiologia , Pessoal de Saúde/psicologia , Pneumonia Viral/complicações , Pneumonia Viral/enfermagem , Estresse Psicológico , Adulto , Betacoronavirus , Brasil/epidemiologia , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Prevalência , Inquéritos e Questionários
15.
J Cardiothorac Surg ; 15(1): 156, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600356

RESUMO

BACKGROUND: The inverse relationship between case volume and postoperative mortality following high-risk surgical procedures have been reported. Thoracic aorta surgery is associated with one of the highest postoperative mortality. The relationship between institutional case volume and postoperative mortality in patients undergoing thoracic aorta replacement surgery was evaluated. METHODS: All thoracic aorta replacement surgeries performed in Korea between 2009 and 2016 in adult patients were analyzed using an administrative database. Hospitals were divided into low (< 30 cases/year), medium (30-60 cases/year), or high (> 60 cases/year) volume centers depending on the annual average number of thoracic aorta replacement surgeries performed. The impact of case volume on in-hospital mortality was assessed using the logistic regression. RESULTS: Across 83 hospitals, 4867 cases of thoracic aorta replacement were performed. In-hospital mortality was 8.6% (191/2222), 10.7% (77/717), and 21.9% (422/1928) in high, medium, and low volume centers, respectively. The adjusted risk of in-hospital mortality was significantly higher in medium (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.16-2.11, P = 0.004) and low volume centers (OR, 3.12; 95% CI, 2.54-3.85, P < 0.001) compared to high volume centers. CONCLUSIONS: Patients who had underwent thoracic aorta replacement surgery in lower volume centers had increased risk of in-hospital mortality after surgery compared to those in higher volume centers. Our results may provide the basis for minimum case volume requirement or regionalization in thoracic aorta replacement surgery for optimal patient outcome.


Assuntos
Aorta Torácica/cirurgia , Procedimentos Cirúrgicos Cardíacos/mortalidade , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Mortalidade Hospitalar , Hospitais Universitários/estatística & dados numéricos , Idoso , Feminino , Hospitais com Alto Volume de Atendimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , República da Coreia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
16.
Saudi Med J ; 41(7): 709-714, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32601638

RESUMO

OBJECTIVES: To assess the prevalence of melanoma and non-melanoma skin cancer for patients attended King Khalid University Hospital, Riyadh, Saudi Arabia. We are also assessing the most common category of skin cancer to be encountered among those patients. Methods: The authors conducted a retrospective study including all patients (Saudi and non-Saudi) who attended King Khalid University Hospital (KKUH) at the period of (2007-2018). Data were collected from archives of Pathology Department at KKUH and categorized into: melanoma skin cancer (MSC), non-melanoma skin cancer (NMSC), which included: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), pre-neoplastic lesions, and non-neoplastic skin lesions. Results: A total of 111 patients were reported to have skin cancer out of 9828 cases, which had other skin pathology. Majority of cases were basal cell carcinoma with a total number of 76 (68.5%) of all cases. 18 patients (16.2%) were diagnosed with MSC. The remaining 17 patients (15.3%) were diagnosed with squamous cell carcinoma. Conclusion: Skin cancer prevalence and incidence is increasing worldwide. In our study, BCC was the most common type of skin cancer to be reported in our institute, which is similar to the majority of other international studies.


Assuntos
Carcinoma Basocelular/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Melanoma/epidemiologia , Neoplasias Cutâneas/epidemiologia , Adulto , Idoso , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Fatores de Tempo
17.
Int J Infect Dis ; 98: 467-469, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32717397

RESUMO

OBJECTIVES: Staphylococcus aureus bacteriuria (SABU) is rare but can be an indicator of S. aureus bacteremia (SAB). The objective of this study was to assess the proportion of SAB in patients with SABU and identify risk factors in a hospital-based population. METHODS: We used electronic databases to identify eligible patients to be enrolled in a retrospective cohort study. Inclusion criteria were (i) SABU, (ii) ≥18 years of age, and (iii) ≥1 blood culture sampled ±3 months of SABU. Patients with missing values for demographic (e.g., age, sex) or clinical characteristics (e.g., comorbidities) and laboratory analyses were excluded. RESULTS: In total, 245 patients attending the University Hospital Münster, Germany, between 1 January 2012 and 31 December 2019 met the inclusion/exclusion criteria. Of the 245 patients with SABU, 66 had a concomitant SAB (26.9%). Elevated C-reactive protein (CRP) levels were associated with SAB. Other parameters (e.g., leukocytes, comorbidities) were not associated with SAB in a multivariate analysis. CONCLUSION: The frequency of SAB in patients with SABU was high and warrants active screening for bloodstream infections in hospitalized patients, particularly if CRP levels are elevated.


Assuntos
Bacteriemia/epidemiologia , Bacteriúria/complicações , Infecções Estafilocócicas/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/etiologia , Bacteriemia/microbiologia , Bacteriúria/diagnóstico , Bacteriúria/epidemiologia , Bacteriúria/microbiologia , Comorbidade , Feminino , Alemanha/epidemiologia , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/fisiologia
18.
Saudi Med J ; 41(6): 614-621, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32518928

RESUMO

OBJECTIVES: To determine the prevalence and types of complementary and alternative medicine (CAM) being utilized and the possible factors that prompted the use of CAM in patients with brain tumors. Methods: The study conducted was a questionnaire-based, cross-sectional study of patients diagnosed with brain tumors at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia from January 2011 to May 2018. Patients with primary and secondary brain tumors, were included. Our questionnaire was conducted via phone interviews after obtaining patient consent.  Results: A total of 72 patients were included. The mean age of the participants was 45.89 (±16.52) years. We found that education level significantly affected the use of CAM. Fewer users of CAM held bachelor's degree and patients with lower degrees used CAM more frequently (p=0.027). The most frequent types of CAM were Zamzam (holy water) and Ruqya (Quran reading). Family members were the most frequent source of information about the use of CAM (81.6%).  Conclusion: Education level has a significant effect on CAM use. Gender plays a role in the type of CAM used. Future research should focus on the adverse effects of some CAM therapies, how effective CAM therapies are, and the effect CAM may play in delaying patients from seeking medical advice.


Assuntos
Neoplasias Encefálicas/terapia , Terapias Complementares/métodos , Terapias Complementares/estatística & dados numéricos , Escolaridade , Hospitais Universitários/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapias Complementares/efeitos adversos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Arábia Saudita/epidemiologia , Fatores Sexuais , Inquéritos e Questionários , Tempo para o Tratamento , Adulto Jovem
19.
Can J Surg ; 63(3): E315-E320, 2020 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-32496034

RESUMO

Background: People of Aboriginal (Indigenous) ancestry are more likely to experience traumatic spinal cord injury (TSCI) than other Canadians; however, outcome studies are limited. This study aims to compare Aboriginal and non-Aboriginal populations with acute TSCI with respect to preinjury baseline characteristics, injury severity, treatment, outcomes and length of stay. Methods: This was a retrospective analysis of participants with a TSCI who were enrolled in the prospective Rick Hansen Spinal Cord Injury Registry (RHSCIR), Saskatoon site (Royal University Hospital), between Feb. 13, 2010, and Dec. 17, 2016. Demographic, injury and management data were assessed to identify any differences between the populations. Results: Of the 159 patients admitted to Royal University Hospital with an acute TSCI during the study period, 62 provided consent and were included in the study. Of these, 21 self-identified as Aboriginal (33.9%) and 41 as non-Aboriginal (66.1%) on treatment intake forms. Compared with non-Aboriginal participants, Aboriginal participants were younger, had fewer medical comorbidities, had a similar severity of neurologic injury and had similar clinical outcomes. However, the time to discharge to the community was significantly longer for Aboriginal participants (median 104.0 v. 34.0 d, p = 0.016). Although 35% of non-Aboriginal participants were discharged home from the acute care site, no Aboriginal participants were transferred home directly. Conclusion: This study suggests a need for better allocation of resources for transition to the community for Aboriginal people with a TSCI in Saskatchewan. We plan to assess outcomes from TSCI for Aboriginal people across Canada.


Assuntos
Grupos Étnicos , Hospitais Universitários/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/métodos , Sistema de Registros , Medição de Risco/métodos , Traumatismos da Medula Espinal/etnologia , Adulto , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Alta do Paciente/tendências , Estudos Retrospectivos , Saskatchewan/epidemiologia
20.
PLoS One ; 15(6): e0234000, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32479516

RESUMO

BACKGROUND: While there are advances in medicine and pharmaceutical care, the burden of medication use has also grown with polypharmacy. In this regard, cardiovascular patients are subjected to polypharmacy for a longer period. OBJECTIVE: The present study aimed to assess the prevalence and predictors of polypharmacy in cardiovascular outpatients attending the University of Gondar Comprehensive specialized hospital, northwest Ethiopia. METHODS: A hospital-based cross-sectional study was employed at the University of Gondar Comprehensive Specialized Hospital from March 30 -May 30, 2019. The unique medical registration number of 424 patients was selected by using systematic random sampling to trace the medical chart and followed with an interview to explore the factors related to polypharmacy. All the Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) version 22. Bivariable and multivariable logistic regressions were used to identify the predictors of polypharmacy in cardiovascular patients. RESULT: The mean age of the respondents was 56.83 ± 15.27 years. The mean number of medications per patient was 3.3±1.6. The prevalence of polypharmacy was 24.8% in cardiovascular outpatients while cardiovascular specific polypharmacy was 9.2%. Elderly (aged ≥ 65 years and above) patients were nearly two times more likely to had polypharmacy prescriptions with AOR: 1.97; 95% CI: 1.08-3.61; p = 0.027. Patients with abnormal weight (underweight AOR: 4.51; 95% CI: 1.42-14.30; p = 0.010, overweight AOR: 3.78; 95% CI: 1.83-7.83; p<0.001 and obese AOR: 5.1; 95% CI: 2.04-12.75 p<0.001) are more likely to have polypharmacy. Having a family history of CVD increase the likelihood of polypharmacy more than double; AOR: 2.40; 95% CI: 1.17-4.93; p = 0.017. A unit increase in Charlson comorbidity index score resulted in a nearly threefold likelihood of polypharmacy with AOR: 2.83; 95% CI 1.91-3.89; p<0.001. CONCLUSION: One out of four cardiovascular patients attending the outpatient clinic was on polypharmacy. The elderly age, abnormal body mass index (non-normal weight), family history of cardiovascular diseases and increasing Charlson morbidity index were the predictors of polypharmacy in cardiovascular patients. Clinicians should ensure the relevance of all prescribed medications and pharmaceutical care targeting at the prevention of inappropriate polypharmacy would be pivotal to reduce polypharmacy associated burdens.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Doenças Cardiovasculares/tratamento farmacológico , Hospitais Universitários/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , Polimedicação , Adolescente , Adulto , Fatores Etários , Idoso , Índice de Massa Corporal , Estudos Transversais , Etiópia , Feminino , Humanos , Prescrição Inadequada/prevenção & controle , Masculino , Anamnese , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
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